The effects of a nutrition care process on protein-energy malnutrition among patients on continuous ambulatory peritoneal dialysis in Chaiyaphum Province, Thailand 10.55131/jphd/2025/230312
Article Sidebar
Main Article Content
Abstract
Nutritional status plays a critical role in managing end-stage renal disease (ESRD) in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). Protein intake is particularly important, as insufficient protein intake can lead to protein-energy malnutrition (PEM), negatively impacting patients’ quality of life (QoL), and impairing patients’ ability to tolerate therapy and recover effectively. This randomized controlled trial aimed to assess the effects of a nutrition care process (NCP) on PEM in 66 patients receiving CAPD, who were randomly assigned to the intervention (n = 33) or the control group (n = 33). The intervention group participated in four sessions of NCP, while the control group received standard care. The program lasted 24 weeks, with follow-up conducted via telephone. Data were collected through structured interviews, and statistical analyses were performed using chi-square, Fisher’s exact test, Cochran’s Q test, repeated measures ANOVA, and independent-samples t-tests. The results indicated a significant reduction in the proportion of patients with PEM in the intervention group at follow-up (P = 0.004), as well as significantly higher mean energy intake, improved food consumption behavior scores, and better QoL than the control group (P < 0.05). The NCP was effective in reducing PEM, enhancing energy intake, improving food consumption behavior, and increasing QoL. We thus recommend extending the NCP to other healthcare settings to better support CAPD patients at risk of PEM and enhance their overall well-being.
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
References
Gunalay S, Ozturk YK, Akar H, Mergen H. The relationship between malnutrition and quality of life in haemodialysis and peritoneal dialysis patients. Rev Assoc Med Bras (1992). 2018 Sep;64(9):845-852. doi: 10.1590/ 1806-9282.64.09.845.
Carrero JJ, Chmielewski M, Axelsson J, Snaedal S, Heimbürger O, Bárány P, Suliman ME, Lindholm B, Stenvinkel P, Qureshi AR. Muscle atrophy, inflammation and clinical outcome in incident and prevalent dialysis patients. Clin Nutr. 2008 Aug;27(4): 557-64. doi: 10.1016/j.clnu.2008.04. 007.
Pongskul C, Sirivongs D, Keobounma T, Chanlertrith D, Promajuk P, Limwatananon C. Survival and technical failure in a large cohort of Thai CAPD patients. J Med Assoc Thai. 2006 Aug;89 Suppl 2: S98-105. PMID: 17044460.
Therrien M, Byham-Gray L, Beto J. A Review of Dietary Intake Studies in Maintenance Dialysis Patients. J Ren Nutr. 2015 Jul;25(4):329-38. doi: 10.1053/j.jrn.2014.11.001. Epub 2015 Jan 13. PMID: 25592493.
Miller WR, Rollnick S. Motivational interviewing: Preparing people to change addictive behavior. Guilford Press; 1991. doi.org/10.1002/casp. 2450020410.
Prochaska JO, Velicer WF. The transtheoretical model of health behavior change. Am J Health Promot. 1997 Sep-Oct;12(1):38-48. doi: 10.4278/0890-1171-12.1.38. PMID: 10170434.
Thiensa-ard J. Effects of counseling program and educating as interview principles for motivating on health behaviors and results from clinic of patients with chronic kidney disease before therapy instead of kidney. J Nurs Pract Thai Midwifery. 2018; 5(2):19-38.
Singhprasert R, et al. The Effect of Behavioral Modification by Advanced Practice Nurses on Clinical Outcomes in Pre-Dialysis Chronic Kidney Disease Patients. Thai J Nurs Council. 2017;5(1):57-74.
Bridle, C., Riemsma, R. P., Pattenden, J., Sowden, A. J., Mather, L., Watt, I. S., & Walker, A. (2005). Systematic review of the effectiveness of health behavior interventions based on the transtheoretical model. Psychology & Health, 20(3), 283–301. https:// doi.org/10.1080/08870440512331333997.
Korkut Y, Balcıoglu İ, Onbası K. Determination of the Perception Level of Life Style Innovations in Type 2 Diabetes Mellitus. Ethiop J Health Sci. 2019 Jul;29(4):447-452. doi: 10.4314/ ejhs. v29i4.5. PMID: 31447517; PMCID: PMC6689712.
Sanitchone, A. (2019). Effect of Motivation Interviewing Consulting on Changing Food Consumption Behavior of Chronic Kidney Disease Patients: -. Journal of Nutrition Association of Thailand (Online), 54(1), 55–68. Retrieved from https:// he01.tci-thaijo.org/index.php/JNAT/ article/view/158026.
Morton K, Beauchamp M, Prothero A, Joyce L, Saunders L, Spencer-Bowdage S, Dancy B, Pedlar C. The effectiveness of motivational interviewing for health behaviour change in primary care settings: a systematic review. Health Psychol Rev. 2015;9(2):205-23. doi: 10.1080/ 17437199.2014.882006.
Sriyakun D, Lapbenjakul S, Srithamrongsawat S, et al. Effectiveness of lifestyle modification program on preventing type 2 diabetes among Thai adults with prediabetes. J Health Syst Res. 2024;18(1):72-92.
Khajehlandi K, Babaei A, Araban M, et al. Effect of Targeted Educational Program Based on the Transtheoretical Model in Promoting Healthy Nutrition Behaviors in Middle-aged Women in Dehdez, Iran. J Educ Community Health. 2019;6(1):25-31. doi: 10. 29252/jech.6.1.25.
Chaiyaphum Provincial Public Health Office. Health Data Center (HDC), Conclusion of data in 43 files in the database. 2021 [Internet]. [Cited 2022 Sep 3]. Available from: https://cpm. hdc.moph.go.th/hdc/main/index.php. [Thai].
Kidney Disease Department. Medical records Chaiyaphum: Chaiyaphum Hospital; 2021.Thai.
Dhupawiroch O, Laplai P, Jirathana K. The Effect of health Behavior Modification Programme on Self-care Behaviors Management Blood Glucose HbA1c Level and Quality of Life among Uncontrolled Diabetic Patients Phra Nakhon Si Ayutthaya Hospital: Randomized Controlled Trial; RCT. JPMAT [internet]. 2023 Jan. 16 [cited 2023 Jan. 21];12(3):552-75. available from: https://he01.tci-thaijo.org/index.php/JPMAT/article/view/258777.
The Nephrology Society of Thailand. Recommendations for nutritional therapy for adult kidney disease patients. Bangkok: The Nephrology Society of Thailand; 2018. Thai.
Faul F, Erdfelder E, Buchner A, Lang A-G. Statistical power analyses using G*Power 3.1: Tests for correlation and regression analyses. Behav Res Methods. 2009; 41:1149-1160.
Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. Erlbaum Associates; 1988.
Wungrath J, Rerkkasem K, Saengyo S, et al. Factors predicting food consumption behavior of hemodialysis patients with end-stage renal disease at Maharaj Nakorn Chiang Mai Hospital. J Health Syst Res. 2018;12(4):625-635.
Homjean K, Sakthong P. Translation and cognitive testing of the Thai version of the Kidney Disease Quality of Life Short-Form Questionnaires Version 1.3. Thai J Pharm Pract. 2019; 2(1):3-14.
Leecharoen P. Application of Transtheoretical Model to Complication Prevention in Patients with Chronic Disease. Nurs J Min Pub Health. 2014;23(3):1-11. [internet]. 2014 Feb. 25 [cited 2022 Dec. 20]; 23(3):1-11. available from: https:// he02.tci-thaijo.org/index.php/tnaph/ article/view/16527.
Hinkhaw C, Loysak B, Nitirat P. Group Motivational Interviewing for Behavior Modification among Uncontrolled Diabetic Patients. JPNC [internet]. 2020 Jun. 23 [cited 2022 Jan. 20];31(1):205-12. available from: https://he01.tci-thaijo.org/index.php/ pnc/article/view/242189.
Ackard DM, Cronemeyer CL, Richter S, Egan A. Do symptom-specific stages of change predict eating disorder treatment outcome? Eat Weight Disord. 2015 Mar;20(1):49-62. doi: 10.1007/s40519-014-0153-0. Epub 2014 Sep 24. PMID: 25249403.
Numpool J. Application of theoretical stages in behavior modification in adult patients with metabolic symptom group. J Thai Red Cross Council. 2020;13(2):15-28.
Ganesan MV, Annigeri RA, Shankar B, Rao BS, Prakash KC, Seshadri R, Mani MK. The protein equivalent of nitrogen appearance in critically ill acute renal failure patients undergoing continuous renal replacement therapy. J Ren Nutr. 2009 Mar;19(2):161-6. doi: 10.1053/j.jrn.2008.11.009. PMID: 19218043.
Khakpour S, Tavafian S, Niknami S, et al. Effect of Combined Education on Promoting Nutritional Behaviors of Female Students. J Educ Community Health. 2016;3(2):41-46. doi: 10.21859/ j ech-03026.
Chanwikrai Y, Wungrath J, Taechangam S, et al. Frequent Snacks Improved Energy Intake and Nutritional Status in Community-Dwelling Older Adults at Risk of Malnutrition, Chiang Mai, Thailand. J Educ Community Health. 2022;9(1): 11-17. doi: 10.34172/jech.2022.3
Rojsuporn S, Piyabanditkul L, Jaiteng A. Food Management for Persons with Diabetes and Hypertension in the Community. J Health Nurs Educ. 2021;27(2):96-111.
Lundahl B, Moleni T, Burke BL, Butters R, Tollefson D, Butler C, Rollnick S. Motivational interviewing in medical care settings: a systematic review and meta-analysis of randomized controlled trials. Patient Educ Couns. 2013 Nov;93(2):157-68. doi: 10.1016/j.pec.2013.07.012. Epub 2013 Aug 1. PMID: 24001658.
Kanitta Wisitjaroen et al. The Effects of a Community Empowerment Program on Behavioral Modification among Buddhist Monks’ Healthcare Leaders and Buddhist Monks to Prevent Non-Communicable Disease Journal of Health and Nursing Education.2024;30(2):1-17. DOI: 10.12982/CMUJASR.2016.0008.
Kulprasutidilok, A., Kulprasutidilok, P. The effects of the community-based lifestyle intervention program on the prevention of Type 2 Diabetes Mellitus among pre-diabetic elderly people at Khlong Lat Phrao community. J Health & Health Manage [internet]. 2021 Dec. 30 [cited 2024 Jan. 10];7(2):129-42. available from: https://he01.tci-thaijo.org/index.php/slc/article/view/250568.
Aguiar R, Pei M, Qureshi AR, Lindholm B. Health-related quality of life in peritoneal dialysis patients: A narrative review. Semin Dial. 2019 Sep;32(5):452-462. doi: 10.1111/ sdi.12770.
Daniel SC, Azuero A, Gutierrez OM, Heaton K. Examining the relationship between nutrition, quality of life, and depression in hemodialysis patients. Qual Life Res. 2021 Mar;30(3):759-768. doi: 10.1007/s11136-020-02684-2.
Madhuri S, Hegde SS, Ravi S, Deepti A, Simpy M. Comparison of chewing ability, oral health related quality of life and nutritional status before and after insertion of complete denture amongst edentulous patients in a Dental College of Pune. Ethiop J Health Sci. 2014 Jul;24(3):253-60. doi: 10.4314/ejhs. v24i3.9.
